Blue cross blue shield of texas prior authorization form pdf

For the latest information on flexibilities and extensions due to COVID-19, refer to the Texas Medicaid & Healthcare Partnership and Texas Health and Human Services Commission websites.

Crisis line for individuals impacted by Texas school shooting

Magellan offers a complimentary 24-hour crisis line for individuals impacted by the elementary school shooting that occurred in Uvalde, Texas on May 24. The toll-free number to access free, confidential consultation services is 1-800-327-7451. In addition, PsychHub has created a publicly accessible trauma response toolkit you may wish to share with your patients.

Texas State Bill 1742: Preauthorization requirements

Preauthorization requirements for Blue Cross and Blue Shield of Texas commercial plans (PDF)

Magellan's annual preauthorization report for BCBSTX commercial plans (PDF) 

Texas House Bill 3041: Renewal of a preauthorization

Provider bulletin regarding Texas HB 3041 (PDF)

Magellan uses ASAM criteria in Texas

In Texas, Magellan uses the American Society of Addiction Medicine (ASAM) criteria as the basis for the utilization reviews of substance use disorder cases.

Standard Prior Authorization Request Form for Health Care Services

Healthcare providers may submit their requests for prior authorization of healthcare services to Magellan using the “Texas Standard Prior Authorization Request Form for Health Care Services.”

The Texas Department of Insurance developed the form to be used to request prior authorization for services for commercial insured members, Medicaid, Medicaid Managed Care, the Children’s Health Insurance Program (CHIP), plans covering employees of the state of Texas, school districts, and the University of Texas and Texas A&M systems.

Please select the appropriate version of the form below based on the members you serve. 

• BlueCross BlueShield of Texas Medicaid STAR, CHIP and STAR Kids (PDF)
• Blue Advantage and Blue Advantage Plus (PDF)
• GeoBlue Texas (PDF)

Providers may continue to call Magellan with their prior authorization requests, as the form does not replace other existing methods of contacting Magellan to request a prior authorization. However, if a provider wishes to request a prior authorization by mail or fax using a form, it must be this form as prescribed by the Texas Department of Insurance.

For preauthorization of psychological testing, in addition to the “Texas Standard Prior Authorization Request Form for Health Care Services,” Magellan also requires the provider to complete and submit the “Request for Psychological Testing Preauthorization” form found on our clinical forms page.

Upon receipt of the completed form(s), Magellan will begin the prior authorization process.

The form cannot be used for any other purpose except to request prior authorization of a healthcare service.

You may direct any questions about the form to Magellan at the phone number on the form.

Texas Medicaid

Find plan-specific and program resources for Texas STAR, STAR Kids and CHIP.

Applied behavior analysis

For Texas-specific ABA resources, sign in to this website. 

From the Resources section, select State & Plan Information, then under State-Specific, click the Texas link to access to access the following forms:

• ABA Provider Orientation
• ABA Initial Authorization
• Texas-specific ABA Treatment Plan/Concurrent Review

March 2020

The big picture: As of Feb. 17, 2020, providers can submit prior authorizations and referrals online using Avality’s Authorizations & Referrals tool (HIPAA-standard 278 transaction). The tool is accessible through the Availity Portal

.

The Authorizations & Referrals tool has improved functionality, making submitting and receiving confirmation from Blue Cross and Blue Shield of Texas (BCBSTX)1 faster and easier.

The bottom line is that the tool will allow providers to:

• Access and verify the status of requests
• Upload clinical medical records
• Edit and/or extend requests
• Obtain printable confirmation number for your records

Get Started!
Begin using the Authorizations & Referrals tool in place of iExchange®. Providers not yet registered with Availity can sign up today at Availity.com

, at no charge. For registration assistance call Availity Client Services at 1-800-282-4548.

Submitting online prior authorization requests using this new tool is easy and consists of only five steps:

1. Log in to Availity
   
   .
2. Select the Patient Registration menu option, choose Authorizations & Referrals, then Authorizations*.
3. Select Payer BCBSTX, then choose your organization.
4. Select Inpatient Authorization or Outpatient Authorization.
5. Review and submit your authorization.

*Choose “Referrals” instead of “Authorizations” if you are submitting a referral request.

Deeper Dive

• BCBSTX’s current electronic prior authorization tool, iExchange, will be deactivated April 15, 2020.
• As of April 15, all electronic prior authorization requests and referrals should be submitted using the new tool. This includes:
• Inpatient admissions
• Select outpatient services
• Behavioral health services
• Referral requests handled by BCBSTX
• Medical and surgical predetermination of benefits requests should be submitted via fax or mail by using the Predetermination Request Form
  
  , along with the pertinent medical documentation.

Note: The process of submitting prior authorization requests to eviCore® or Magellan Healthcare® is not changing.

For More Information
Review Availity Authorizations & Referrals, added to the Provider Tools section of our website. If you need further assistance or customized training, contact our Provider Education Consultants.

1Providers should continue to use their current prior authorization process until this new application becomes available for Federal Employee Program®(FEP®) members and all plans requiring a BCBSTX prior authorization for behavioral health services.

iExchange is a trademark of Medecision, Inc., a separate company that provides collaborative health care management solutions for payers and providers.

eviCore is an independent specialty medical benefits management company that provides utilization management services for BCBSTX. eviCore is wholly responsible for its own products and services.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX. BCBSTX makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as eviCore and Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.

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